Bone health across the generations: a primer for health providers concerned with osteoporosis prevention

Defining the key clinician skills and attributes for competency in managing patients with osteoporosis and fragility fractures

Osteoporosis and fragility fractures are managed by clinicians across many medical specialties. The key competencies of clinicians delivering bone health care have not been systematically established. We aimed to develop a decision rule to define the threshold of adequate skills and attributes associated with clinical competency in bone health for a clinician serving as a referral source for bone health care. Using a modified-Delphi method, we invited clinicians with expertise in treating osteoporosis and representatives of patient advocacy groups focused on bone health to create a list of desirable characteristics of a clinician with bone health competency. Characteristics were defined as "attributes" with "levels" within each attribute. Participants prioritized levels by perceived importance. To identify the cut points for defining adequate competency, participants next ranked 20 hypothetical clinicians defined by various levels of attributes from highest to lowest likelihood of having adequate bone health competency. Lastly, we conducted a discrete choice experiment (DCE) to generate a weighted score for each attribute/level. The threshold for competency was a priori determined as the total weighted score at which ≥70% of participants agreed a clinician had adequate bone health competency. Thirteen participants generated lists of desirable characteristics, and 30 participants ranked hypothetical scenarios and participated in the DCE. The modified-Delphi exercise generated 108 characteristics, which were reduced to 8 categories with 20 levels with associated points. The maximum possible score was 25 points. A summed threshold score of >12 points classified a clinician as having adequate bone health competency. We developed a numeric additive decision rule to define clinicians across multiple specialties as having adequate competency in managing bone health/osteoporosis. Our data provide a rigorously defined criteria for a clinician with competency in bone health and can be used to quantitate the skills of clinicians participating in bone health research and clinical care.

Noninflammatory Stress-Induced Remodeling of Mandibular Bone: Impact of Age and Pregnancy

PURPOSE

The impact of noninflammatory stress, such as aging and pregnancy, on human long bone remodeling is well-established, but little is known about the impact of these stressors on oral bones, including the mandibular bone. To begin to fill this gap in our knowledge, we utilized a mouse mandibular model to evaluate the impact of noninflammatory simple stressors, ie, aging and pregnancy, on bone mandibular architecture and bone density in the mandible using micro-CT.

MATERIALS AND METHODS

For the present study, mandibles were obtained from both aged and pregnant C57BL/6 mice and analyzed using micro-CT technology. Micro-CT metrics included bone volume fraction (BVF), total volume (TV), tissue density, and apparent density in the mandible on the mandibular area of compact and trabecular bone, in which the teeth are embedded. All bone-related metrics data from aged and pregnant mice were analyzed using ANOVA analysis and visualized in boxplots.

RESULTS

Age-dependent bone remodeling occurred over 4 to 18 weeks of age, ie, increases in BVF, TV, BV/TV, as well as tissue and bone density. Evaluation of bone remodeling in breeder mice (repeated pregnancy model) and virgin mice (age-matched controls) at 37 weeks of age demonstrated that breeder mice had a dramatic decline in all bone metrics measured.

CONCLUSIONS

This study underscores the need for more research on noninflammatory stress-related mandibular bone remodeling (eg, age and pregnancy), which compromises bone strength and tooth anchoring. The data also underscores loss of alveolar bone height, as in periodontitis, is an important metric for a more complete assessment of bone loss. This report on mice provides essential data that can be applied for oral-maxillofacial surgeons and periodontists when planning for dental implants in patients with such stressors. Periodontitis related bone loss occurs independent of skeletal homeostasis, although osteoporosis may adversely affect alveolar bone height in humans.

Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women

OBJECTIVES

The aim of this study was to investigate factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women.

METHODS

This is a cross-sectional study and included 886 women. Data were collected with a questionnaire including questions about demographics and independent variables tested, the Menopause Symptom Checklist and The MOS 36-Item Short Form Health Survey.

RESULTS

The mean age of the women included in the study was 48.62 years (standard deviation (S.D.)=5.75, range: 40-60 years). Of all women, 32.1% were premenopausal, 23.9% perimenopausal and 44.2% postmenopausal. Stepwise multiple regression analyses, performed to determine factors associated with menopausal symptom score, revealed 12 statistically significant variables which increased the strength of the model. These variables were as follows in the order of their contribution to the strength of the model: health problems, recent life stresses, being a primary school graduate, absence of relaxation methods, number of pregnancy, financial problems, tea consumption, inadequate and unbalanced nutrition, coffee consumption, age, being a secondary school graduate and dissatisfaction in marriage. Besides, there was a significant and moderately negative relation between total menopausal symptom scores and quality of life scores.

CONCLUSIONS

A large number of factors were associated with experiencing menopausal symptoms and menopausal symptoms had negative effects on the quality of life among Turkish women. Stress management and health promoting practices should be incorporated into menopausal care programs to improve health and quality of life of middle-aged women.

Osteoporosis and atherosclerosis: biological linkages and the emergence of dual-purpose therapies

Osteoporosis and atherosclerosis are both widely prevalent in an ageing population, and induce serious morbidities and death. There is growing evidence that in addition to their relationship to ageing, osteoporosis and atherosclerosis are also linked by biological associations. This article reviews their clinical interrelations, discusses the basic biology of bone and the arterial wall, and presents five examples that illustrate their biological linkages. Current therapeutic approaches emerging from these linkages, including statins, bisphosphonates, and the thiazolidinediones, have dual effects on bone and the vasculature. Additional therapies derived from experimental studies that enhance bone density and reduce atherogenesis hold further promise to diminish the morbidity and mortality of osteoporosis and atherosclerosis, with attendant benefits to society.